Thanks for taking time to read this- similar to lots of other questions so sorry and thanks in advance. I have had two sex partners and one additional oral sex partner. All sex was a one time event oral was two times. All of these encounters were pre 2007. In fact oral took place early 2006. All girls were known to get around. No relations since then. March 2010 I was working a lot and had constant pressure in my urethra. Two herpselct tests, both negative, no lesions. I had the tests done as the Internet scared me. Fast forward to last week. The base of my penis hurts, look around- poke prod and manipulate but don't see anything. Next morning I see a sebaceous gland filled and pop it white puss comes out. That night still have pain and see three cuts or scabs. Worry about herpes go to a nurse practitioner who says he sees lots of STDs. Says it does not look like traditional herpes but does another herpselect. Negative- type one is .08 and 2 is .36. I have read on this forum time and time again herpselect is not good for hsv 1. Should I worry the scabs cuts were indeed herpes, or chalk it up to manipulating the area. The area still hurts and still has cuts as I keep playing with it. Do you recommend western blot in my case with three tests three years apart. What kind of odds would vegas give? Thanks

You have had almost as low risk a sexual lifestyle that I can imagine, other than celibacy. Very few people with such few partnerships or sexual experiences acquire any STDs. As for your symptoms, while it is true that herpes in theory could cause penile scabs, almost always the scabs would be preceded by a cluster (not scattered lesions) of typical red bumps, becoming blisters, then ulcers, then scabs, all over 7-14 days. And of course your negative blood test result for both HSV types is strong evidence you aren't infected.

In other words, the cumulative evidence -- your sexual history, symptoms, your doctor's opinion, and test results -- adds up to virtual certainty that you don't have genital herpes due to either HSV-1 or HSV-2. Of course if you ever develop more typical symptoms like a cluster of penile blisters or sores, return promptly to your doctor for reevaluation. But I am ver confident that won't happen. You really shouldn't be at all worried about herpes or any other STD.

I forgot to add that herpes lesions and sebaceous cysts are entirely different; neither is likely to be confused with the other by an experienced clinician. In addition, herpes outbreaks are uncommon in the pubic area, base of the penis, and other hair-bearing areas, but these are exactly where sebaceous lesions are most common.

The scabs were clusters- but probably a function of playing with the area. From an epidemiologist standpoint, does herpselect for hsv1 have a high enough positive predictive value for me to rely upon. Does the low value .08 mean anything, or is a negative a negative regardless if one is at zero or .89?

The important issue in test performance is actually negative predictive value, i.e. the level of confidence that the negative result is valid. Sensitivity of the test for HSV-1 is probably around 80%. With the low prior probability that you have genital HSV-1, for the reasons in my reply above, that translates to well over 99% negative PV.

With most or all of the current crop of EIA tests that give optical density (OR) ratios as the outcome, any value below the positive cut-off is negative. If the cut-off is 0.9 (as for most HSV tests), there is no difference in meaning of, say, 0.1, 0.5, or 0.8; all are totally negative. In fact, the identical specimen tested several times, often will give widely varying OD ratios, especially with different batches of test reagents.

Not only is a WB unnecessary, it would be a mistake. The WB is LESS sensitive than the ELISA tests; it's main use is not to find infection in people with negative ELISA, but to confirm unexpectedly positive or equivocal ELISA. Moreover, even if you were to have a positive blood test for HSV-1, it would not say anythng about your genital symptoms. Oral HSV-1 is a lot more common than genital, and most oral cases are asymptomatic. So a positive result would probably indicate oral infection, not genital.

Also, you may not be aware that people with definite genital herpes due to HSV-1 have few recurrent outbreaks (often none at all), little asymptomatic genital shedding, and therefore rarely transmit the infection sexually to future partners. In other words, it really doesn't matter very much.

As already discussed, it is very unlikely you have genital HSV-1 and it probably wouldn't matter if you did. So my advice is to just ignore this entire business and go on with your life. You need not say anything about it to future sex partners.

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